Abstract
The presence of overt hepatic encephalopathy (HE) is associated with structural, metabolic and functional changes in the brain discernible by use of a variety of magnetic resonance (MR) techniques. The changes in patients with minimal HE are less well documented. Twenty-two patients with well-compensated cirrhosis, seven of whom had minimal HE, were examined with cerebral 3 Tesla MR techniques, including T1- and T2-weighted, magnetization transfer and diffusion-weighted imaging and proton magnetic resonance spectroscopy sequences. Studies were repeated after a 4-week course of oral L-ornithine L-aspartate (LOLA). Results were compared with data obtained from 22 aged-matched healthy controls. There was no difference in mean total brain volume between patients and controls at baseline. Mean cerebral magnetization transfer ratios were significantly reduced in the globus pallidus and thalamus in the patients with cirrhosis irrespective of neuropsychiatric status; the mean ratio was significantly reduced in the frontal white matter in patients with minimal HE compared with healthy controls but not when compared with their unimpaired counterparts. There were no significant differences in either the median apparent diffusion coefficients or the mean fractional anisotropy, calculated from the diffusion-weighted imaging, or in the mean basal ganglia metabolite ratios between patients and controls. Psychometric performance improved in 50 % of patients with minimal HE following LOLA, but no significant changes were observed in brain volumes, cerebral magnetization transfer ratios, the diffusion weighted imaging variables or the cerebral metabolite ratios. MR variables, as applied in this study, do not identify patients with minimal HE, nor do they reflect changes in psychometric performance following LOLA.
Highlights
It is widely accepted that the presence of minimal hepatic encephalopathy (HE) has negative effects on quality of life and survival (Weissenborn 2015)
Psychometric performance improved in 50 % of patients with minimal HE following L-ornithine L-aspartate (LOLA), but no significant changes were observed in brain volumes, cerebral magnetization transfer ratios, the diffusion weighted imaging variables or the cerebral metabolite ratios
This study was designed to investigate whether measures of cerebral volume, water content and metabolite concentrations, obtained using cerebral magnetic resonance (MR) imaging and spectroscopy, could be used to differentiate patients with minimal HE from their neuropsychiatrically unimpaired counterparts and/or to monitor the effects of measures designed to change neuropsychiatric status
Summary
It is widely accepted that the presence of minimal hepatic encephalopathy (HE) has negative effects on quality of life and survival (Weissenborn 2015). The absence of such a measure is likely to hamper the progress of therapeutic trials of medications that may be of benefit to people with this condition. The Psychometric Hepatic Encephalopathy Score (PHES) battery (Weissenborn et al 2001) is considered to provide the best clinical standard for evaluating cognitive function in patients with cirrhosis, testing can be time-consuming and language-specific normative data are not available for all population subsets. Cerebral magnetic resonance imaging (MRI) is a useful tool for non-invasively assessing brain structure, and provides measures of cerebral volume and brain water content. The techniques which have been utilized in patient with HE include:
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